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Home » Medical Forms » Reptile Husbandry Questionnaire

Reptile Husbandry Questionnaire

Client Name

Patient Name

Known/Estimated Age

Species

Sex

Male

Female

Unknown

Is this a guess/how we know

Current History

Why are we here today

Duration of Problem

Any treatments/medications give

Coughing?

Yes

No

Sneezing?

Yes

No

Nasal/Oral Discharge?

Yes

No

Diarrhea?

Yes

No

Vomiting/Regurgitation?

Yes

No

Changes in Appetite?

Yes

No

Changes in Activity?

Yes

No

Past History

Where did you acquire?

How long in your care?

Prior medical concerns or diagnoses

Have you been to a vet before this?

Yes

No

If Yes, Where?

Treatments?

Daily Life

Do they get regular soaks?

When was their last shed?

How often are they handled?

Do they interact with any other animals?

Do they go outside?

Husbandry

Enclosure

Enclosure size and type

Substrate type

How often is substrate cleaned

Is substrate bioactive?

What is in the substrate?

Enclosure features (hides, furniture, toys, etc) (brands, materials, etc)

Temperature, Lighting, Humidity

Are there thermometer(s)?

Yes

No

If Yes, Where is it located

Daytime temperatures

Nighttime temperatures

Heat sources

UVB Light?

Yes

No

Brand

Last changed

Is there a hygrometer?

Yes

No

If Yes, Where is it located

Daytime humidity

Nighttime humidity

Diet

What food types are they offered?

Frequency of each food type?

Do they eat every meal/how much per meal?

How is food offered?

How often is food bowl/tongs cleaned?

Any supplements/vitamins?

Frequency

When did they last eat?

Water

Water source available

How often is it cleaned?

Can your reptile climb in and out of the water source?

Yes

No

Picture of your enclosures

Max. file size: 50 MB.

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(847) 885-3344

51 E Remington Rd.,
Schaumburg, IL 60173

make an appointment

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Monday

Open 24 Hours

Tuesday

Open 24 Hours

Wednesday

Open 24 Hours

Thursday

Open 24 Hours

Friday

Open 24 Hours

Saturday

Open 24 Hours

Sunday

Open 24 Hours

Our hospital is open for walk-in care 24/7, however we have appointments for general practice wellness visits Monday - Friday 8am-7pm and Saturdays from 8am - 3pm. Walk-in emergencies will be prioritized and pets with non-urgent needs will be seen as soon as possible.

(847) 885-3344

51 E Remington Rd.,
Schaumburg, IL 60173

make an appointment

Home
Our Hospital
Services
Lodge & Grooming
Resources
Online Pharmacy
Contact Us
- Email Golf Rose
- My Pet is Lost

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